b'Scientific Session Abstracts SUNDAY APRIL 21, 2024 42: LONG-TERM FOLLOW-UP OF SAPHENOUS VEIN ARTERIALIZATION FOR LIMB SALVAGE IN UNRECONSTRUCTABLE PERIPHERAL ARTERIAL DISEASEHailey Shoemaker, MPH,1, David L. Lau MD,2, Brent A. Safran MD, 2 ,Michael B. Brewer MD,21 Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA2 Vascular & Endovascular Surgery, Department of Surgery, Kaiser Permanente Downey Medical Center, Downey, California.Background: Chronic limb-threatening ischemia (CLTI) including ischemic rest pain, non-healing ulcers, or gangrene, is associated with significant morbidity and mortality and remains a challenge in vascular surgery. Up to 40% of patients with CLTI have severe unreconstructable disease with no endovascular option and no distal target for surgical bypass, often requiring major amputation. Great saphenous vein arterialization (GSVA) is a promising technique to improve distal perfusion and avoid otherwise inevitable amputation in these patients. Small case series in the literature are promising, but 12-month outcomes are largely unavailable. In this case series, we contribute 12-month outcomes for patients with CTLI treated with GSVA since 2019.Methods: From October 2019March 2023, 10 patients with unreconstructable CLTI were treated with GSVA. The GSV was anastomosed in-situ to the most distal patent artery. The vein was exposed at the ankle, valvulotomy was performed proximally, and pedal venous valvuloclasty performed distally using a long flushing olive tip catheter. Venous branches along the GSV were ligated. Limb pain, wound healing, and subsequent amputations were evaluated through chart review through January 2024. Primary endpoints include relief of rest pain, wound healing, and amputation-free survival time.Results: GSVA procedures were performed for tissue loss on 13 limbs in 10 patients (80% male) with an average age of 62.9 years. All were technically successful with no major operative complications and restoration of pedal Doppler signals. The proximal anastomosis was the below-knee popliteal artery in 9 limbs and the proximal superficial femoral artery in 4 limbs. Comorbidities such as diabetes (92%), hypertension (92%), hyperlipidemia (85%), and smoking history (69%) were common. 9/10 patients (12/13 limbs) had greater than 12 months of follow-up. Below-knee amputation (BKA)-free survival at 12 months for the 12 limbs with at least 12 months of follow up was58.3%. 12-month survival to any amputation including toe, transmetatarsal, or BKA was 23.1%. Average follow-up was 17.2 months (0.2 - 49.2 months) for all patients from date of surgery to their last clinic appointment, BKA, or death. Wound healing and improvement in pain was reported for 8 (62%) and 7 limbs (54%) respectively, though 9 limbs (69%) were still painful at the end of the follow up period. All BKAs took place within 1.5 months of the GSVA. Average amputation-free follow-up time in 8 limbs not requiring a BKA was 27.4 (range: 5.4-49.2) months.Conclusion: GSVA with pedal venous valvuloclasty is a promising option for limb salvage in patients with CLTI otherwise facing major amputation. The procedure successfully prevented amputation, promoted wound healing, and reduced rest pain at over one year of follow-up in over half of patients who would otherwise have required BKA.42 NDANNUAL MEETING|APRIL 1921, 2024|OCEANSIDE, CA 107'